Detailed diagnostic work-up

Limbic encephalitis:2 years on the wrong medication

Services

Detailed Medical Summary: Complete review of the client’s medical chart, lab results and imaging studies, as well as a thorough medical history by our team, revealed that the client had probably been misdiagnosed.

Isolated Review of Imaging: Re-read of the Brain MRIs at Harvard revealed that limbic encephalitis had been missed.

Attendance at Doctor’s Appointments: Discussion of the facts with his Danish physicians led to an apology from the neurology department and additional diagnostic tests which confirmed the diagnosis of limbic encephalitis.

Client Advocacy: After the diagnosis was confirmed in Denmark, GMI advocated to have the client’s care transferred to a leading expert in limbic encephalitis in Denmark. This occurred and the specialist was receptive to the feedback from Harvard.

Remote Second Opinion: A subspecialist in limbic encephalitis at Harvard reviewed the case and made treatment recommendations regarding management of the limbic encephalitis as well as tapering off the 10 medications erroneously prescribed for “bipolar disorder.”

Case

Problem: A 62 year old man was diagnosed with bipolar disorder after his first episode of mania. He had received an extensive medical work-up including 4 MRI scans of his brain and a lumbar puncture, and had been told that there was no neurological disorder. He requested a second opinion just as a meeting was being called with his senior doctors in Denmark to discuss the next steps for his treatment. Upon review of his chart and test results, GMI became concerned that the client had a neurological disorder, and that his MRI scans and lumbar puncture had not been read or interpreted properly.

COST OF GMI’s SERVICES

80,000dkk for review and translation of the medical journal, face-to-face history, writing a detailed medical summary, re-read of 3 MRIS, 1 remote second opinion, attendance at doctors’ appointments and continued follow-up.

Solution: GMI summarized his medical history, reviewed his chart and attended the meeting with his senior doctors where the evidence suggesting a diagnosis of limbic encephalitis was presented to his treatment team. The team was receptive to the feedback, his case was re-opened by the neurological service, all labs requested by GMI were ordered and his neurologist called him at home to apologize personally for the mistake. His MRIs were re-read by a radiologist at Harvard- MGH, confirming the diagnosis of limbic encephalitis, and a world-renowned specialist in limbic encephalitis at Harvard – MGH was consulted to do a second opinion by e-mail.

Impact: The diagnosis of limbic encephalitis was confirmed in Denmark and the necessary work-up to rule-out paraneoplastic limbic encephalitis due to cancer was undertaken. We confirmed that he did not have cancer and treatment was started for autoimmune limbic encephalitis with the input of the second opinion consultant from Harvard. The client’s medical team was most receptive to the second opinion process and called GMI personally with updates and test results so as to optimize his outcome. Senior specialists in Denmark were consulted to oversee his care in Denmark. As he became healthier, he wanted to be educated about his disease and taught to advocate for himself.

Quote

“I have never in my entire life met a more competent doctor than Nikki Gordon Skovby. Based upon her second opinion services and her brilliance, I was re-diagnosed from having a psychiatric disorder to having a curable somatic illness. She was able to work seamlessly with the existing Danish public healthcare system and no conflicts emerged throughout the process. That is really an achievement worth noting.”